'Lesbian Health 101' seeks to open doors, minds

MEDICINE

Published 4:00 am, Sunday, February 14, 2010

When Dr. Patricia Robertson held the first lesbian health clinic at San Francisco General Hospital in 1978, she decided to cover the "family planning" signs in the lobby - she didn't want to deter patients who thought gynecologists were only for dispensing birth control and helping women get pregnant.

Health resources have improved for lesbians in the three decades since. But noticeable gaps in health care remain. Lesbians are more likely than straight women to suffer depression and drug and alcohol abuse. They may be less likely to get regular health screenings like pap smears and breast exams.

"We wanted to put together evidence-based research that would support clinical guidelines, so when we talk about why lesbians are different from heterosexual women we can back that up," said Robertson, who is a professor in the UCSF department of obstetrics, gynecology and reproductive sciences. "Doctors are going to be able to legitimize their advice after they read this book."

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Chapters in the nearly 600-page book focus on a wide variety of health issues, from heart disease and breast cancer to partner violence and how to decide which woman in a relationship should get pregnant.

Some sections focus on the risk factors that affect lesbians more than straight women - higher smoking rates, for example, or what effect not having children might have on breast cancer risks - while others address how doctors can best meet the particular needs of lesbian patients.

Many of the health issues that affect lesbians can be tied to stress related to their sexual orientation, Dibble said. Discrimination, the stress of coming out to family and friends, or feeling ostracized and alone can all lead to health problems.

"People sometimes think that the only difference between lesbians and straight women is how we have sex. But the difference is more in our families, our friends, and the stigma associated with being a lesbian that affects health," Dibble said. "If you could get rid of the stigma I don't think you'd need the book."

Much of writing by lesbians

The textbook is written in medical language and designed for doctors, nurses and other health care providers, although Robertson and Dibble say they're encouraging lesbians to use it as a resource for understanding their own health issues. Most of the chapters were written by health care providers who are also lesbian.

Much of the book centers around how health care providers can make their practices more sensitive and responsive to lesbian patient needs. For example, the first chapter discusses the various reasons why lesbians may put off doctor visits - everything from fearing discrimination to simply believing they don't need to see a gynecologist as often as straight women.

"If you go into an ob-gyn office and you are inundated with baby pictures, how do you feel if you're a lesbian with no kids?" Dibble said. "We want health care providers to signal that it's a good thing for lesbians to come in - that it's fine, that it's A-OK. You want things in your office that are culturally appropriate, even if it's just a sign that we don't discriminate."

Doctors also need to be prepared to offer health resources specific to lesbian needs, Dibble said. That might mean tracking down support groups with a lesbian focus for depression or substance abuse, or identifying a local women's shelter for lesbians who have been the victim of domestic violence.

Vital reference for doctors

Dr. Erica Breneman, an obstetrician-gynecologist with Kaiser Permanente in Oakland, said she's pleased to see such a textbook available to doctors now, even if it's troubling that the book is even necessary.

"In a perfect world, we wouldn't need this," Breneman said. "A woman who happens to be gay shouldn't need much that's terribly different than a woman who is straight. But the reality is, because of the particular demographics of lesbian women, they do have other health issues."